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Impact of the COVID-19 pandemic on the incidence of anorexia and bulimia nervosa in Dutch primary care.
Meier, K., Hoeken, D. van, Kager, C.C.M., Eeden, A.E. van, Oldehinkel, A.J., Hoek, H.W. Impact of the COVID-19 pandemic on the incidence of anorexia and bulimia nervosa in Dutch primary care. The International Journal of Eating Disorders: 2025
Objective
This study examined the impact of the COVID-19 pandemic on incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in Dutch primary care by comparing pre-pandemic (2015-2019) and in-pandemic (2020-2022) periods. We hypothesized that the incidence of AN and BN would increase during the pandemic.
Method
This retrospective cohort study used data from general practitioners' electronic health records from the Nivel Primary Care Database, representing ~0.8% of the Dutch population. Incident AN and BN cases were identified using DSM-5 criteria. Incidence rates (IR) per 100,000 person-years were calculated and compared using incidence rate ratios (IRRs).
Results
Overall incidence rates of AN and BN did not increase significantly during the pandemic (AN: IRR = 1.2, 95% CI = 0.8-1.8; BN: IRR = 0.9, 95% CI = 0.5-1.8). Non-significant increases in AN were observed among females overall (+29%, IRR = 1.3, 95% CI = 0.9-2.0) and among 10- to 14-year-old females (+28%, IRR = 1.3, 95% CI = 0.4-3.7). The BN incidence decreased significantly among females aged 20-24 years from 53.8 to 10.7 per 100,000 person-years (IRR = 0.2, 95% CI = 0.0-0.9).
Discussion
Contrary to our hypothesis, we did not find increased incidence rates during the pandemic. The overall incidence of AN among females increased non-significantly by 29%. The previously observed rising trend in AN among 10- to 14-year-old females in 1985-2019 did not have a significant sequel into the pandemic era, although it increased by 28%. The BN incidence remained stable overall and decreased significantly among young adult females.
This study examined the impact of the COVID-19 pandemic on incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in Dutch primary care by comparing pre-pandemic (2015-2019) and in-pandemic (2020-2022) periods. We hypothesized that the incidence of AN and BN would increase during the pandemic.
Method
This retrospective cohort study used data from general practitioners' electronic health records from the Nivel Primary Care Database, representing ~0.8% of the Dutch population. Incident AN and BN cases were identified using DSM-5 criteria. Incidence rates (IR) per 100,000 person-years were calculated and compared using incidence rate ratios (IRRs).
Results
Overall incidence rates of AN and BN did not increase significantly during the pandemic (AN: IRR = 1.2, 95% CI = 0.8-1.8; BN: IRR = 0.9, 95% CI = 0.5-1.8). Non-significant increases in AN were observed among females overall (+29%, IRR = 1.3, 95% CI = 0.9-2.0) and among 10- to 14-year-old females (+28%, IRR = 1.3, 95% CI = 0.4-3.7). The BN incidence decreased significantly among females aged 20-24 years from 53.8 to 10.7 per 100,000 person-years (IRR = 0.2, 95% CI = 0.0-0.9).
Discussion
Contrary to our hypothesis, we did not find increased incidence rates during the pandemic. The overall incidence of AN among females increased non-significantly by 29%. The previously observed rising trend in AN among 10- to 14-year-old females in 1985-2019 did not have a significant sequel into the pandemic era, although it increased by 28%. The BN incidence remained stable overall and decreased significantly among young adult females.
Objective
This study examined the impact of the COVID-19 pandemic on incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in Dutch primary care by comparing pre-pandemic (2015-2019) and in-pandemic (2020-2022) periods. We hypothesized that the incidence of AN and BN would increase during the pandemic.
Method
This retrospective cohort study used data from general practitioners' electronic health records from the Nivel Primary Care Database, representing ~0.8% of the Dutch population. Incident AN and BN cases were identified using DSM-5 criteria. Incidence rates (IR) per 100,000 person-years were calculated and compared using incidence rate ratios (IRRs).
Results
Overall incidence rates of AN and BN did not increase significantly during the pandemic (AN: IRR = 1.2, 95% CI = 0.8-1.8; BN: IRR = 0.9, 95% CI = 0.5-1.8). Non-significant increases in AN were observed among females overall (+29%, IRR = 1.3, 95% CI = 0.9-2.0) and among 10- to 14-year-old females (+28%, IRR = 1.3, 95% CI = 0.4-3.7). The BN incidence decreased significantly among females aged 20-24 years from 53.8 to 10.7 per 100,000 person-years (IRR = 0.2, 95% CI = 0.0-0.9).
Discussion
Contrary to our hypothesis, we did not find increased incidence rates during the pandemic. The overall incidence of AN among females increased non-significantly by 29%. The previously observed rising trend in AN among 10- to 14-year-old females in 1985-2019 did not have a significant sequel into the pandemic era, although it increased by 28%. The BN incidence remained stable overall and decreased significantly among young adult females.
This study examined the impact of the COVID-19 pandemic on incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in Dutch primary care by comparing pre-pandemic (2015-2019) and in-pandemic (2020-2022) periods. We hypothesized that the incidence of AN and BN would increase during the pandemic.
Method
This retrospective cohort study used data from general practitioners' electronic health records from the Nivel Primary Care Database, representing ~0.8% of the Dutch population. Incident AN and BN cases were identified using DSM-5 criteria. Incidence rates (IR) per 100,000 person-years were calculated and compared using incidence rate ratios (IRRs).
Results
Overall incidence rates of AN and BN did not increase significantly during the pandemic (AN: IRR = 1.2, 95% CI = 0.8-1.8; BN: IRR = 0.9, 95% CI = 0.5-1.8). Non-significant increases in AN were observed among females overall (+29%, IRR = 1.3, 95% CI = 0.9-2.0) and among 10- to 14-year-old females (+28%, IRR = 1.3, 95% CI = 0.4-3.7). The BN incidence decreased significantly among females aged 20-24 years from 53.8 to 10.7 per 100,000 person-years (IRR = 0.2, 95% CI = 0.0-0.9).
Discussion
Contrary to our hypothesis, we did not find increased incidence rates during the pandemic. The overall incidence of AN among females increased non-significantly by 29%. The previously observed rising trend in AN among 10- to 14-year-old females in 1985-2019 did not have a significant sequel into the pandemic era, although it increased by 28%. The BN incidence remained stable overall and decreased significantly among young adult females.
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